Metabolic dysregulation in psychotic mania: longitudinal cardiometabolic changes with exploratory analyses of serum uric acid.

Psychotic mania, a severe form of bipolar disorder, presents with elevated mood, hyperactivity, and psychotic symptoms. It is frequently accompanied by metabolic dysregulation, increasing the risk of metabolic syndrome and cardiovascular morbidity. This study investigates whether serum uric acid and metabolic parameters can serve as state or trait biomarkers in individuals with psychotic mania. It further examines their relationships with clinical outcomes and psychopathological changes across various phases of the illness. This study employed a prospective study design involving 30 patients with psychotic mania, 30 first-degree relatives, and 30 age- and sex-matched healthy controls. Serum uric acid levels and various metabolic parameters were analyzed concurrently to elucidate their potential interrelationship. Serum uric acid levels showed no significant changes between baseline (mean ± SD: 5.84 ± 1.74 mg/dL) and follow-up (mean ± SD: 5.15 ± 1.63 mg/dL). However, notable increases were observed in triglycerides (from 125.73 ± 69.67 to 169.07 ± 72.46 mg/dL, p = 0.010), systolic blood pressure (from 116.80 ± 7.59 to 119.80 ± 6.99 mm Hg, p < 0.001), and body mass index (BMI) (from 20.90 ± 3.91 to 21.12 ± 3.91 kg/m², p < 0.001). Negative correlations emerged between changes in uric acid and select metabolic indicators, including triglycerides and low-density lipoprotein (LDL). This study demonstrates the necessity for integrated care approaches that address both psychiatric symptoms and metabolic health in patients with psychotic mania, emphasizing the potential of uric acid as a marker of underlying metabolic dysfunction.